As an Emory employee or student, you are insured for professional and general liability exposures for activities falling within the course and scope of your employment or training within the Emory system.  Professional liability insurance protects you in the event a claim is asserted against you in connection with your "professional" responsibilities as a physician, nurse, resident, teacher, lawyer, etc.  General liability insurance protects you in the event a claim is asserted against you in connection with non-professional responsibilities, such as the obligation to maintain a safe campus environment or the duty to live up to the terms of a contract.   

This document provides you with information about your liability insurance coverage as an employee or student at Emory.

Q.    WHAT IS EMORY'S LIABILITY INSURANCE PROGRAM?

 A.     The Emory system is insured for professional and general liability exposures under a comprehensive multi-layered program in which the system retains a portion of risk through a captive insurance company subsidiary and transfers the remaining risk to the commercial market. 

A captive insurance company is a company formed to insure the risks of its parent.  Clifton Casualty Insurance Company Ltd. ("CCIC") retains the primary limit of $3,000,000 per claim for professional liability and $1,000,000 per claim for general liability.  Additional limits are purchased in excess of the primary layer and the amount of excess insurance is determined annually.

 Q.  DOES THE PROFESSIONAL LIABILITY INSURANCE PROVIDED TO ME BY EMORY COVER ALL OF MY PROFESSIONAL SERVICES?

A.     If you are employed at Emory, you are insured for activities falling within the course and scope of your employment within the system.  In some instances, your insurance may be extended to include acts at a non-Emory facility if the compensation for that service is received by Emory, the activity is undertaken at the direction of your Section or Program Head, and it has been approved by the Chief Executive Officer of your institution.

 Q.  IF I LEAVE EMORY, WILL I BE COVERED FOR CLAIMS ARISING OUT OF ACTIVITIES IN WHICH I PARTICIPATED WHILE I WAS STILL EMPLOYED OR TRAINING WITHIN THE EMORY SYSTEM?

A.     The Emory insurance program is written on a "claims-made" basis but it has been modified to cover claims and suits arising from events which occurred while you were with Emory even if the claim or suit is brought after you leave the system.  At the present time, you do not need to purchase "tail" coverage when you leave Emory, no matter what reason you have for leaving. 

 Q.    WHO IS ON THE BOARD OF THE CAPTIVE?

A.     The CCIC Board is composed of members of the Emory Board of Trustees and senior management, faculty and medical staffs of Emory.

 Q.    MANY INSURANCE COMPANIES SETTLE MOST CASES FOR ECONOMIC REASONS REGARDLESS OF MERIT OR LACK OF MERIT.  IS THIS EMORY'S PHILOSOPHY?

A.     No. Emory's philosophy is to carefully evaluate each case on its own merits.  If there is clear liability on the part of the insured, settlement in a reasonable amount related to the nature and extent of injury will be pursued.  If liability is unclear, discovery will be undertaken to gather whatever information is necessary to make a settlement decision.  Cases lacking merit will be vigorously defended.

Q. WHAT DO I DO IF A CLAIM IS MADE AGAINST ME OR I AM SERVED WITH LAWSUIT?

A.  If you receive notice of a claim or a lawsuit, you should immediately contact the Office of Risk & Insurance Services.  Staff will meet with you to go over the circumstances surrounding the matter in which you have been noticed.  Individuals from claims and risk management will familiarize you with the claims management process to help you deal with the anxiety and stress that are natural and inevitable reactions to being sued.

 Q.  WILL I HAVE INPUT INTO THE SETTLEMENT OF CLAIMS OR SUITS IN WHICH I AM INVOLVED?

A.     Yes.  Whenever a claim or suit in which you are involved is evaluated for settlement, your opinion and input will be requested. Your thoughts are valuable in assessing the strengths and weaknesses of the case in order to make a settlement decision.

 Q.    I HAVE SEEN INSURANCE POLICIES THAT REQUIRE THE POLICYHOLDER, OR INSURED, TO "COOPERATE" WITH THE COMPANY.  DOES THE EMORY PROGRAM HAVE THIS SAME REQUIREMENT AND, IF SO, WHAT DOES IT MEAN?

A.     Yes.  The Emory Program requires that its insureds cooperate and assist in the investigation, evaluation, and assessment of all cases.  Your assistance in gathering information is critical in helping to assure that all facts pertinent to the case can be discovered.  You are also required to cooperate with outside counsel, when assigned, and Emory's claims management staff in order to prepare a defense.

 Q. HOW DOES EMORY ASSESS THE MERITS OF A CASE AND DEVELOP ITS STRATEGY?

A.     When a claim is asserted or a lawsuit is filed, the Office of Risk & Insurance Services will review the care provided to identify any possible breaches in the applicable standard of care.  Emory physicians, with expertise in the relevant areas, may be asked to review the clinical aspects of the case.  Most often this individual will be a Section Head in the relevant specialty.  Expert reviewers not affiliated with Emory may also review the case and provide a formal opinion if the case proceeds to litigation.

On a monthly basis, cases are presented to the Emory Healthcare Clinical Claims Review Working Group to obtain advice on the merits of individual cases, to develop defense strategies, and to obtain settlement authority when necessary. Strategy is further developed through consultation with the involved physician and defense counsel.  Strategy will, of course, differ from case to case depending on the circumstances of each individual case.

 Q.       HOW ARE DEFENSE COUNSEL SELECTED AND ASSIGNED TO CASES?

A.     Reputable defense counsel with expertise in professional liability actions are identified and interviewed to determine the philosophy of the firm, degree of expertise, staffing, fees, and willingness to adhere to Emory expectations in terms of timeliness, preparation, and approach to litigation.  Qualified defense firms, willing to commit to Emory's standards, are recommended to the Emory Healthcare Clinical Claims Review Working Group for final approval.  Adherence to established guidelines and expectations is closely monitored.  Counsel that fails to meet these requirements will be dropped from the approved list.

When individual cases are assigned to defense counsel, the particular counsel's expertise, the facts of the case and "fit" with the defendants are all considered.  Every attempt is made to assure that defendants are comfortable with assigned counsel. 

 Q.       WILL I AUTOMATICALLY RECEIVE EVIDENCE OF INSURANCE?

A.    No.  If you require evidence of insurance, please contact the Office of Risk & Insurance Services at (404) 778-7937.

If you have any further questions or require additional information, please contact:

Cheryl France, Director                                          Laura Deane, Director
Insurance & Loss Control Programs                            Risk Management
404-778-7932                                                          404-778-4301